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  • How good are the outcomes of instrumented debulking operations for symptomatic spinal metastases and how long do they stand? A subgroup analysis in the global spine tumor study group database
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-17
    Bart Depreitere, Federico Ricciardi, Mark Arts, Laurent Balabaud, Cody Bunger, Jacob M. Buchowski, Chun Kee Chung, Maarten Hubert Coppes, Michael George Fehlings, Norio Kawahara, Juan Antonio Martin-Benlloch, Eric Maurice Massicotte, Christian Mazel, Bernhard Meyer, Fetullah Cumhur Oner, Wilco Peul, Nasir Quraishi, Yasuaki Tokuhashi, Katsuro Tomita, Jorrit-Jan Verlaan, Michael Wang, Hugh Alan Crockard, David Choi

    Abstract Background The benefits of surgery for symptomatic spinal metastases have been demonstrated, largely based on series of patients undergoing debulking and instrumentation operations. However, as cancer treatments improve and overall survival lengths increase, the incidence of recurrent spinal cord compression after debulking may increase. The aim of the current paper is to document the postoperative evolution of neurological function, pain, and quality of life following debulking and instrumentation in the Global Spine Tumor Study Group (GSTSG) database. Methods The GSTSG database is a prospective multicenter data repository of consecutive patients that underwent surgery for a symptomatic spinal metastasis. For the present analysis, patients were selected from the database that underwent decompressive debulking surgery with instrumentation. Preoperative tumor type, Tomita and Tokuhashi scores, EQ-5D, Frankel, Karnofsky, and postoperative complications, survival, EQ-5D, Frankel, Karnofsky, and pain numeric rating scores (NRS) at 3, 6, 12, and 24 months were analyzed. Results A total of 914 patients underwent decompressive debulking surgery with instrumentation and had documented follow-up until death or until 2 years post surgery. Median preoperative Karnofsky performance index was 70. A total of 656 patients (71.8%) had visceral metastases and 490 (53.6%) had extraspinal bone metastases. Tomita scores were evenly distributed above (49.1%) and below or equal to 5 (50.9%), and Tokuhashi scores almost evenly distributed below or equal to 8 (46.3%) and above 8 (53.7%). Overall, 12-month survival after surgery was 56.3%. The surgery resulted in EQ-5D health status improvement and NRS pain reduction that was maintained throughout follow-up. Frankel scores improved at first follow-up in 25.0% of patients, but by 12 months neurological deterioration was observed in 18.8%. Conclusion We found that palliative debulking and instrumentation surgeries were performed throughout all Tomita and Tokuhashi categories. These surgeries reduced pain scores and improved quality of life up to 2 years after surgery. After initial improvement, a proportion of patients experienced neurological deterioration by 1 year, but the majority of patients remained stable.

    更新日期:2020-01-17
  • Detection of spreading depolarizations in a middle cerebral artery occlusion model in swine
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-15
    Modar Kentar, Martina Mann, Felix Sahm, Arturo Olivares-Rivera, Renan Sanchez-Porras, Roland Zerelles, Oliver W. Sakowitz, Andreas W. Unterberg, Edgar Santos

    The main objective of this study was to generate a hemodynamically stable swine model to detect spreading depolarizations (SDs) using electrocorticography (ECoG) and intrinsic optical signal (IOS) imaging and laser speckle flowmetry (LSF) after a 30-h middle cerebral artery (MCA) occlusion (MCAo) in German Landrace Swine.

    更新日期:2020-01-17
  • Serum myelin basic protein as a marker of brain injury in aneurysmal subarachnoid haemorrhage
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-08
    Norbert Wąsik, Bartosz Sokół, Marcin Hołysz, Witold Mańko, Robert Juszkat, Piotr Paweł Jagodziński, Roman Jankowski

    Abstract Background Myelin basic protein (MBP) is the second most abundant protein in central nervous system myelin. Since the 1980s, it has been regarded as a marker of brain tissue injury in both trauma and disease. There have been no recent reports regarding MBP in aneurysmal subarachnoid haemorrhage (SAH). Methods One hundred four SAH patients with ruptured aneurysms underwent endovascular treatment within 24 h of rupture, and 156 blood samples were collected: 104 on days 0–3, 32 on days 4–6 and 20 on days 9–12 post-SAH. MBP levels were assayed using ELISA and compared with the clinical status on admission, laboratory results, imaging findings and treatment outcome at 3 months. Results MBP levels on days 0–3 post-SAH were significantly higher among poor outcome patients (p < 0.001), non-survivors (p = 0.005), patients who underwent intracranial intervention (p < 0.001) and patients with intracerebral haemorrhage (ICH; p < 0.001). On days 4–6 post-SAH, significantly higher levels were found following intracranial intervention (p = 0.009) and ICH (p = 0.039). There was clinically relevant correlation between MBP levels on days 0–3 post-SAH and 3-month Glasgow Outcome Scale (cc = − 0.42) and also ICH volume (cc = 0.48). All patients who made a full recovery had MBP levels below detection limit on days 0–3 post-SAH. Following endovascular aneurysm occlusion, there was no increase in MBP in 86 of the 104 patients investigated (83%). Conclusions The concentration of MBP in peripheral blood after intracranial aneurysm rupture reflects the severity of the brain tissue injury (due to surgery or ICH) and correlates with the treatment outcome. Endovascular aneurysm occlusion was not followed by a rise in MBP in most cases, suggesting the safety of this technique.

    更新日期:2020-01-17
  • Peri-operative prognostic factors for primary skull base chordomas: results from a single-center cohort.
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-16
    Emanuele La Corte, Morgan Broggi, Alberto Raggi, Silvia Schiavolin, Francesco Acerbi, Giovanni Danesi, Mariangela Farinotti, Giovanni Felisati, Alberto Maccari, Bianca Pollo, Marco Saini, Claudia Toppo, Francesca Valvo, Riccardo Ghidoni, Maria Grazia Bruzzone, Francesco DiMeco, Paolo Ferroli

    Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients.

    更新日期:2020-01-16
  • Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-15
    Hussam Aldin Hamou, Konstantin Kotliar, Sonny Kian Tan, Christel Weiß, Blume Christian, Hans Clusmann, Gerrit Alexander Schubert, Walid Albanna

    Abstract Background For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set. Method We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up. Results Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05). Conclusions Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.

    更新日期:2020-01-15
  • Subperiosteal versus subdural drainage after burr hole evacuation of chronic subdural hematoma: systematic review and meta-analysis
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-15
    Raymond Pranata, Hadrian Deka, Julius July

    Abstract Background The evidence for subperiosteal drainage (SPD) versus subdural drainage (SDD) in chronic subdural hematoma (CSDH) remains controversial, and most surgeons prefer to use SDD over SPD. We aim to assess the latest evidence on the use of SPD compared to SDD in patients with CSDH undergoing burr hole evacuation. Methods We performed a systematic literature search on topics that assesses the use of SPD compared to SDD in patients with CSDH up until November 2019 from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, and ClinicalTrials.gov. The primary outcome was recurrent CSDH, and the secondary outcomes were mortality, surgical morbidities, and modified Rankin Score (mRS). Results There were a total of 3241 subjects from 10 studies. SPD was shown to reduce recurrent CSDH (OR 0.66 [0.52, 0.84], p < 0.001; I2: 17%, p = 0.30) compared to SDD. Recurrent CSDH was lower in SPD group in subgroup analysis at 3-months (OR 0.63 [0.49, 0.81]; I2: 68%, p = 0.04) and 6-months (OR 0.66 [0.51, 0.85], p = 0.001; I2: 77%, p = 0.01) follow-up. However, there was no difference in CSDH recurrence upon subgroup analysis of RCTs. Similar mortality was demonstrated between SPD and SDD group (p = 0.13). The occurrence of parenchymal injury/new neurological deficit was significantly lower in SPD group (OR 0.26 [0.14, 0.51], p < 0.001; I2: 49%, p = 0.08). The rate of seizure, (p = 0.57), postoperative bleeding (p = 0.29), and infection (p = 0.25) were shown to be similar in both SPD and SDD group. Overall, the rate of surgical morbidity was significantly lower in SPD group (OR 0.61 [0.44, 0.85], p = 0.003; I2: 16%, p = 0.25). mRS at the end of follow-up was similar in SPD and SDD group (p = 0.12). Conclusion SPD was associated with less CSDH recurrence, but similar rate of mortality, seizures, postoperative bleeding, and infections compared to SDD. The rate of parenchymal injury/new neurological deficit was lower in the SPD group.

    更新日期:2020-01-15
  • Cervical posterior foraminotomy: how i do it
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-14
    Giulia Cossu, Mahmoud Messerer, Juan Barges-Coll

    Cervical pathologies are addressed through a variety of anterior and posterior approaches and minimally invasive procedures have been successfully applied during the last decades. Posterior cervical foraminotomy (PCF) should be proposed with isolated foraminal stenosis.

    更新日期:2020-01-14
  • Techniques and challenges of the expanded endoscopic endonasal access to the ventrolateral skull base during the “far-medial” and “extreme medial” approaches
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-13
    Giuliano Silveira-Bertazzo, Sunil Manjila, Nyall R. London, Daniel M. Prevedello

    Expanding the ventrolateral skull base corridor from the midline of lower clivus to the petroclival fissure is a challenging endonasal surgical task. Resection of lytic lesions like chondrosarcoma can cause cranial nerve morbidities and injury of ICA, necessitating accurate knowledge of correlative endoscopic anatomy with stereotactic landmarks.

    更新日期:2020-01-13
  • Symptomatic developmental venous anomalies
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-11
    Lorenzo Rinaldo, Giuseppe Lanzino, Kelly D. Flemming, Timo Krings, Waleed Brinjikji

    Abstract Cerebral developmental venous anomalies (DVAs) are variations of venous vascular anatomy related to an underdevelopment of either the superficial or deep venous emissary system, resulting in a dilated transmedullary vein fed by multiple smaller venous radicles responsible for drainage of normal brain parenchyma. While typically benign and found incidentally on imaging studies, DVAs can rarely be symptomatic. The radiographic appearance of DVAs, as well as their symptomatic manifestations, is diverse. Herein, we will discuss the pathophysiology of symptomatic DVAs while providing illustrative case examples depicting each of their pathogenic mechanisms.

    更新日期:2020-01-13
  • Disseminated pneumocephalus secondary to air compressor injury
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-10
    H Suisa, GE Sviri

    We report an unusual case of a young male patient who presented with severe pain and swelling of his left eyelid following an air compressor tip accident. He suffered extensive facial edema accompanied by deep tissue emphysema and an elevated intraocular pressure. On noncontrast CT scan, air was detected in the intraconal and extraconal orbital compartments, and intracranially within the subarachnoid spaces as well as in the suprasellar and perimesencephalic cisterns. There were no detectable fractures. We presume that by perforating the orbital septum, Tenon’s capsule, and the optic nerve sheath, air had managed to penetrate the cranium through the optic nerve subarachnoid space and into the intracranial subarachnoid space.

    更新日期:2020-01-11
  • Onyx embolization of skull base paragangliomas: a single-center experience
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-10
    Joshua S. Catapano, Rami O. Almefty, Dale Ding, Alexander C. Whiting, Andrew R. Pines, Kent R. Richter, Andrew F. Ducruet, Felipe C. Albuquerque

    Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx.

    更新日期:2020-01-11
  • The extended eyebrow approach a cadaveric stepwise dissection
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-09
    Rafael Martinez-Perez, Douglas A. Hardesty, Ricardo L. Carrau, Daniel M. Prevedello

    Abstract Background The eyebrow incision supraorbital approach is limited by the lack of exposure of the sylvian fissure exposure. By extending the skin incision 15 mm posteriorly and the supraorbital craniotomy beneath the superior temporal line, proximal sylvian dissection is achievable, and the surgical exposure is drastically improved. Methods Throughout a cadaveric stepwise dissection and a pertinent anatomical analysis, we describe in detail the surgical technique of the extended eyebrow approach (xEBA). We additionally highlight main anatomical elements involved in this approach and provide technical nuances to avoid complications. Conclusion xEBA is a versatile technique that uses the pretemporal, transylvian, and subfrontal corridor to enhance surgical exposure around the anterior cranial fossa.

    更新日期:2020-01-09
  • The effects of chronic subthalamic stimulation on nonmotor symptoms in advanced Parkinson’s disease, revealed by an online questionnaire program
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-02
    Minako Kawaguchi, Kazuhiro Samura, Yasushi Miyagi, Tsuyoshi Okamoto, Ryo Yamasaki, Nobutaka Sakae, Fumiaki Yoshida, Koji Iihara

    This study was designed to detect and assess the frequency and severity of nonmotor symptoms (NMSs) in advanced Parkinson’s disease (PD) and to investigate the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on NMSs.

    更新日期:2020-01-09
  • How I do it: superficial temporal artery to middle cerebral artery bypass for treatment of giant middle cerebral artery aneurysm
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-06
    Walter C. Jean, Daniel R. Felbaum, Hung M. Ngo

    Giant middle cerebral artery aneurysms are frequently anatomically complicated. Trapping may yield poor outcome, and bypass revascularization is often necessary as an adjunctive treatment to preserve flow.

    更新日期:2020-01-06
  • Cut-off values for sufficient cortisol response to low dose Short Synacthen Test after surgery for non-functioning pituitary adenoma
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-06
    Anders Jensen Kolnes, Kristin Astrid Øystese, Daniel Dahlberg, Jon Berg–Johnsen, Pitt Niehusmann, Jens Pahnke, Jens Bollerslev, Anders Palmstrøm Jørgensen

    Abstract Objective The aim was to study the prevalence of secondary adrenal insufficiency before and after surgery for non-functioning pituitary adenomas, as well as determine risk factors for developing secondary adrenal insufficiency. A secondary aim was to determine adequate p-cortisol response to a 1-μg Short Synacthen Test after surgery. Design Longitudinal cohort study. Methods One hundred seventeen patients (52/65 females/males, age 59 years) undergoing primary surgery for clinically non-functioning pituitary adenomas were included. P-cortisol was measured in morning blood samples. Three months after surgery, a Short Synacthen Test was performed. Results All tumours were macroadenomas (mean size 26.9 mm, range 13–61 mm). The surgical indications were visual impairment (93), tumour growth (16), pituitary apoplexy (6) and headache (2). Before surgery, 17% of the patients had secondary adrenal insufficiency (SAI), decreasing to 15% 3 months postoperatively. Risk of SAI was increased in patients operated for pituitary apoplexy (p < 0.001), while age, sex, tumour size and complication rate were not different from the remaining cohort. Three months after surgery, all patients with baseline p-cortisol ≥ 172 nmol/l (6.2 μg/dl) and peak p-cortisol during Short Synacthen Test ≥ 320 nmol/l (11.6 μg/dl) tapered cortisone unproblematically. In patients with intact hypothalamic-pituitary-adrenal axis, p-cortisol peaked < 500 nmol/l (18.1 μg/dl) during Short Synacthen Test in 48% of patient. Conclusion Pituitary surgery is safe and transsphenoidal surgery rarely causes new SAI. Relying solely on morning p-cortisol for diagnosing secondary adrenal insufficiency gives false positives and the Short Synacthen Test remains useful. A peak p-cortisol ≥ 320 during (11.6 μg/dl) Short Synacthen Test indicates a sufficient response, while < 309 nmol/l (11.2 μg/dl) indicates secondary adrenal insufficiency.

    更新日期:2020-01-06
  • Efficacy and safety of middle meningeal artery embolization in the management of refractory or chronic subdural hematomas: a systematic review and meta-analysis
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-04
    Fareed Jumah, Muhammad Osama, Abdurrahman I. Islim, Ammar Jumah, Devi Prasad Patra, Jennifer Kosty, Vinayak Narayan, Anil Nanda, Gaurav Gupta, Rimal Hanif Dossani

    Abstract Introduction Refractory or chronic subdural hematomas (cSDH) constitute a challenging entity that neurosurgeons face frequently nowadays. Middle meningeal artery embolization (MMAE) has emerged in the recent years as a promising treatment option. However, solid evidence that can dictate management guidelines is still lacking. Methods We conducted a systematic review and meta-analysis (MA) in compliance with the PRISMA guidelines to evaluate the efficacy and safety of MMAE compared with conventional treatments for refractory or cSDH. Databases were searched up to March 2019. Using a random-effects model, meta-analyses of proportions and risk difference were conducted recurrence, need for surgical rescue, and complications. Results Eleven studies (177 patients) were included. Majority (116, 69%) were males with a weighted mean age of 71 + −19.5 years. Meta-analysis of proportions showed treatment failure to be 2.8%, need for surgical rescue 2.7%, and embolization-related complications 1.2%. Meta-analysis of risk-difference between embolized and non-embolized patients showed a 26% (p < 0.001, 95% CI 21%–31%, I2 = 0) lower risk of hematoma recurrence in MMAE. Similarly, in the embolized group, the need for surgical rescue was 20% less (p < 0.001, 95% CI = 12%–27%, I2 = 12.4), and complications were 3.6% less (p = 0.008, 95% CI 1%–6%, I2 = 0) compared to conventional groups. Conclusions Although MMAE appears to be a promising treatment for refractory or cSDH, drawing definitive conclusions remains limited by paucity of data and small sample sizes. Multicenter, randomized, prospective trials are needed to compare embolization to conventional treatments like watchful waiting, medical management, or surgical evacuation. More extensive research on MMAE could begin a new era in the minimally invasive management of cSDH.

    更新日期:2020-01-04
  • Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-04
    Mattis A. Madsbu, Øyvind Salvesen, Sven M. Carlsen, Steinar Westin, Kristian Onarheim, Øystein P. Nygaard, Tore K. Solberg, Sasha Gulati

    Abstract Background There is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals. Methods Data were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays. Results Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year follow-up. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days). Conclusion At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals.

    更新日期:2020-01-04
  • Improving capacity and access to neurosurgery in sub-Saharan Africa using a twinning paradigm pioneered by the Swedish African Neurosurgical Collaboration
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-04
    Enoch O. Uche, Wilfred C. Mezue, Obinna Ajuzieogu, Christopher C. Amah, Ephraim Onyia, Izuchukwu Iloabachie, Mats Ryttlefors, Magnus Tisell

    The unmet need for neurosurgery in sub-Saharan Africa is staggering. Resolving this requires strategies that synergize salient local resources with tailored foreign help. This study is a trial of a twinning model adopted by the Swedish African Neurosurgical Collaboration (SANC).

    更新日期:2020-01-04
  • How I do it: contralateral supraorbital approach for tuberculum sellae meningioma
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-03
    Ivo Peto, Timothy G. White, Amir R. Dehdashti

    The resection of tuberculum sellae meningiomas poses a challenge particularly when dealing with the medial aspect of the optic nerve. Dissection of the tumor off the optic nerve is usually carried out in the blind spot “behind” the optic nerve. We describe a contralateral approach for asymmetric tuberculum sellae meningiomas, allowing direct visualization of the medial optic nerve.

    更新日期:2020-01-04
  • Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-03
    L. Giammattei, P. di Russo, N. Penet, S. Froelich

    Abstract Background The anterolateral approach (ALA) enables to access the craniovertebral junction (CVJ), lower and middle clivus, jugular foramen, and cervical spine from a lateral perspective. It is particularly indicated when dealing with extradural bone tumors. Other rare indications are represented by spondylotic myeloradiculopathy and vascular diseases. Method We describe here the steps to safely perform an anterolateral approach along with a brief description of its indications and limits. Conclusion ALA represents a valid option to treat cervical spine and CVJ bone tumors such as chordomas. Its knowledge can improve the process of approach selection when dealing with such complex cases.

    更新日期:2020-01-04
  • How I do it: dorsolateral approach for ventrolateral intramedullary cavernoma
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-03
    Corentin Dauleac, Isabelle Pelissou-Guyotat

    For small and lateral lesions, in order to avoid postoperative sequelae related to dorso-median myelotomy, we propose to describe the use of a ventrolateral approach for intramedullary lesions.

    更新日期:2020-01-04
  • Endoscopic posterior cervical foraminotomy via a single stab incision for contiguous two-level cervical radiculopathy
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-03
    Zhipeng Xi, Yang Lu, Lin Xie

    Endoscopic posterior cervical foraminotomy (EPCF) is an effective surgical treatment method for single-level cervical radiculopathy. However, only few studies have used the technique for two-level EPCF via a single stab incision.

    更新日期:2020-01-04
  • Tonsillectomy with modified reconstruction of the cisterna magna with and without craniectomy for the treatment of adult Chiari malformation type I with syringomyelia
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-02
    Bolin Liu, Yuan Wang, Shujuan Liu, Yufu Zhang, Dan Lu, Lei Chen, Tao Zheng, Tianzhi Zhao, Lanfu Zhao, Eric W. Sankey, Guodong Gao, Yan Qu, Shiming He

    In light of the controversies regarding the surgical treatment of adult Chiari malformation type I (CM-I) with syringomyelia, a retrospective study was conducted to evaluate the safety and efficacy of tonsillectomy followed by modified reconstruction of the cisterna magna with or without craniectomy.

    更新日期:2020-01-04
  • Neuromuscular choristoma-associated desmoid-type fibromatosis: Establishing a nerve territory concept
    Acta Neurochir. (IF 1.834) Pub Date : 2020-01-02
    Andrés A. Maldonado, Robert J. Spinner, Stephen M. Broski, Jonathan J. Stone, B. Matthew Howe, Jodi M. Carter

    Desmoid-type fibromatosis (DTF) frequently arises in patients with neuromuscular choristoma (NMC). We hypothesize that NMC-associated DTF occurs in soft tissues innervated by the NMC-affected nerve, and arises from CTNNB1-mutated (myo) fibroblasts within or directly adjacent to the NMC.

    更新日期:2020-01-04
  • 更新日期:2020-01-04
  • Correction to: Arachnoiditis as an outcome factor for microvascular decompression in classical trigeminal neuralgia
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-20
    Edoardo Mazzucchi, Andrei Brinzeu, Marc Sindou

    Figure 3 corrected.

    更新日期:2020-01-04
  • Quantitative anatomical comparison of transnasal and transcranial approaches to the clivus.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Edoardo Agosti,Giorgio Saraceno,Jimmy Qiu,Barbara Buffoli,Marco Ferrari,Elena Raffetti,Francesco Belotti,Marco Ravanelli,Davide Mattavelli,Alberto Schreiber,Lena Hirtler,Luigi F Rodella,Roberto Maroldi,Piero Nicolai,Fred Gentili,Walter Kucharczyk,Marco M Fontanella,Francesco Doglietto

    BACKGROUND AND OBJECTIVE The clivus was defined as "no man's land" in the early 1990s, but since then, multiple approaches have been described to access it. This study is aimed at quantitatively comparing endoscopic transnasal and microsurgical transcranial approaches to the clivus in a preclinical setting, using a recently developed research method. METHODS Multiple approaches were performed in 5 head and neck specimens that underwent high-resolution computed tomography (CT): endoscopic transnasal (transclival, with hypophysiopexy and with far-medial extension), microsurgical anterolateral (supraorbital, mini-pterional, pterional, pterional transzygomatic, fronto-temporal-orbito-zygomatic), lateral (subtemporal and subtemporal transzygomatic), and posterolateral (retrosigmoid, far-lateral, retrolabyrinthine, translabyrinthine, and transcochlear). An optic neuronavigation system and dedicated software were used to quantify the working volume of each approach and calculate the exposure of different clival regions. Mixed linear models with random intersections were used for statistical analyses. RESULTS Endoscopic transnasal approaches showed higher working volume and larger exposure compared with microsurgical transcranial approaches. Increased exposure of the upper clivus was achieved by the transnasal endoscopic transclival approach with intradural hypophysiopexy. Anterolateral microsurgical transcranial approaches provided a direct route to the anterior surface of the posterior clinoid process. The transnasal endoscopic approach with far-medial extension ensured a statistically larger exposure of jugular tubercles as compared with other approaches. Presigmoid approaches provided a relatively limited exposure of the ipsilateral clivus, which increased in proportion to their invasiveness. CONCLUSIONS This is the first anatomical study that quantitatively compares in a holistic way exposure and working volumes offered by the most used modern approaches to the clivus.

    更新日期:2019-11-01
  • Third ventricle floor bowing: a useful measurement to predict endoscopic third ventriculostomy success in infantile hydrocephalus.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Qiguang Wang,Jian Cheng,Zhang Si,Qiang Li,Xuhui Hui,Yan Ju

    BACKGROUND Preoperative judgment who will benefit from endoscopic third ventriculostomy (ETV) in infantile hydrocephalus remains controversial and no sufficient clue exists. Although ETV success score (ETVSS) is a useful scale in predicting ETV success in hydrocephalus, its efficacy in infants younger than 1 year old has been limited. This study aimed to verify the efficacy of a newly defined sign, "third ventricle floor bowing (TVFB)," in predicting ETV success in infantile hydrocephalus for the first time and discuss the mechanism of this sign and its clinical meanings. METHODS Between January 2013 and April 2018, hydrocephalic infants (age ≤ 12 months) with third ventricle floor bowing were treated endoscopically in the Department of Neurosurgery, West China Hospital. The medical records of these patients were reviewed. Additionally, we undertook a detailed review of the reported data on the treatment of infantile hydrocephalus with endoscopic third ventriculostomy (ETV). RESULTS A total of 42 infants underwent ETV alone in our institution, with a median age of 7.3 ± 3.8 months. Common etiologies included postinfectious (26.2%), arachnoid cyst (14.3%), aqueductal stenosis (11.9%), and congenital condition (11.9%). The complications included seizure (2.4%), CSF leak (2.4%), and subdural effusion (2.4%). During the average follow-up of 21.7 ± 13.1 months, the ETV success rate predicted by third ventricle floor bowing (TVFB) was 71.4%, which was higher than 6-month success rate predicted by the ETVSS (52.3%). However, it was difficult to reach statistical significance (P = 0.072) due to the limited sample size and further studies with larger sample size were needed. CONCLUSIONS Our study suggests TVFB can serve as a useful method for selecting ETV candidates in infantile hydrocephalus preoperatively. And we speculate that good ventricle compliance and pressure difference between the ventricle and subarachnoid space are essential elements in ensuring ETV success.

    更新日期:2019-11-01
  • External validation of cerebral aneurysm rupture probability model with data from two patient cohorts.
    Acta Neurochir. (IF 1.834) Pub Date : 2018-10-31
    Felicitas J Detmer,Daniel Fajardo-Jiménez,Fernando Mut,Norman Juchler,Sven Hirsch,Vitor Mendes Pereira,Philippe Bijlenga,Juan R Cebral

    BACKGROUND For a treatment decision of unruptured cerebral aneurysms, physicians and patients need to weigh the risk of treatment against the risk of hemorrhagic stroke caused by aneurysm rupture. The aim of this study was to externally evaluate a recently developed statistical aneurysm rupture probability model, which could potentially support such treatment decisions. METHODS Segmented image data and patient information obtained from two patient cohorts including 203 patients with 249 aneurysms were used for patient-specific computational fluid dynamics simulations and subsequent evaluation of the statistical model in terms of accuracy, discrimination, and goodness of fit. The model's performance was further compared to a similarity-based approach for rupture assessment by identifying aneurysms in the training cohort that were similar in terms of hemodynamics and shape compared to a given aneurysm from the external cohorts. RESULTS When applied to the external data, the model achieved a good discrimination and goodness of fit (area under the receiver operating characteristic curve AUC = 0.82), which was only slightly reduced compared to the optimism-corrected AUC in the training population (AUC = 0.84). The accuracy metrics indicated a small decrease in accuracy compared to the training data (misclassification error of 0.24 vs. 0.21). The model's prediction accuracy was improved when combined with the similarity approach (misclassification error of 0.14). CONCLUSIONS The model's performance measures indicated a good generalizability for data acquired at different clinical institutions. Combining the model-based and similarity-based approach could further improve the assessment and interpretation of new cases, demonstrating its potential use for clinical risk assessment.

    更新日期:2019-11-01
  • Electrical cortical stimulation for treatment of intractable epilepsy originating from eloquent cortex: surgical accuracy and clinical efficacy.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Ching-Yi Lee,Tony Wu,Chun-Wei Chang,Siew-Na Lim,Mei-Yun Cheng,Shih-Tseng Lee

    BACKGROUND Electrical cortical stimulation is shown effective in treating patients with drug-resistant epilepsy. We demonstrated how detailed procedures of pre- and intra-operative planning of cortical stimulation implantation may influence the results of seizure reduction rate. METHODS To confirm the precision of subdural grids covering the epileptogenic foci in the eloquent regions, pre- and intra-operative video-electroencephalography (VEEG) were performed in patients with drug-resistant epilepsy during a 4-day 24-h monitoring. The localization of the grid was determined via 3D reconstruction imaging of subdural electrodes co-registered onto the patient's cortex. A final quadripolar lead in cyclic stimulation mode was then placed and secured on the target cortex area. Post-operative 3D CT ensured the accurate location of stimulation lead without any misplacement. Bipolar cyclic stimulation and post-implantation VEEG were performed for 7 days. Patients were discharged and followed up regularly for parameters adjustment and recording of seizure outcomes. RESULTS Eight patients received chronic cortical stimulation implantations between February 2003 and December 2017. The mean age of these patients was 21.1 years old and the average post-operative follow-up was 77.3 months. Comparisons of their seizure frequency at baseline and during the postoperative period revealed a mean reduction in seizures of 60.4% at the first year and 65.6% at the second year. CONCLUSIONS Pre-surgical planning enhanced the accuracy of electrode placement and led to a favorable seizure reduction rate. Our report confirms that electrical cortical stimulation with detailed implantation procedures is safe and effective for patients with drug-resistant epilepsy originating from eloquent cortex.

    更新日期:2019-11-01
  • Increased plasma plasmin-α2-plasmin inhibitor complex levels correlate with postoperative rebleeding after endoscopic surgery for spontaneous intracerebral hemorrhage.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Kenji Yagi,Yoshifumi Tao,Keijirou Hara,Eiichiro Kanda,Satoshi Hirai,Hiroki Takai,Keita Kinoshita,Yukari Mimani,Yuko Miyazaki,Naoki Oyama,Yoshiki Yagita,Shunji Matsubara,Masaaki Uno

    BACKGROUND Postoperative rebleeding (PR) is one of the most severe complications of endoscopic surgery, often performed to remove spontaneous intracerebral hemorrhage (sICH). However, the risk factors for PR remain unclear. OBJECTIVE This study retrospectively investigated whether increased preoperative plasma plasmin-α2-plasmin inhibitor complex (PIC) levels, indicating activation of fibrinolysis, are associated with PR. METHODS A total of 101 patients underwent endoscopic surgery to evacuate sICH at our institution from January 2010 to March 2019, and 79 patients who underwent examinations of plasma PIC levels at admission with available radiographical data were included. Correlations between PR and increased plasma PIC levels were retrospectively evaluated. RESULTS PR occurred in eight patients (10.1%), and high PIC levels (≥ 4 or 6 μg/ml) were significantly associated with PR. The sensitivities employing high PIC levels of ≥ 4 μg/ml and ≥ 6 μg/ml were both 0.63, and the specificities using the same PIC levels were 0.86 and 0.92, respectively. Multivariable analyses showed that high plasma PIC levels of ≥ 4 μg/ml (odds ratio (OR), 12.77; 95% confidence interval (CI), 1.65-98.77; p = 0.02) or ≥ 6 μg/ml (OR, 18.33; 95% CI, 2.32-144.82; p = 0.006) were independent predictors of PR. CONCLUSIONS This study found that increased plasma PIC levels were associated with PR following the endoscopic evacuation of sICHs, indicating that increased plasma PIC levels could be potentially used to predict PR. Further studies are needed to establish new surgical strategies and adjuvant treatments to improve surgical outcomes in patients with sICH prone to PR.

    更新日期:2019-11-01
  • Analysis of seven prognostic scores in patients with surgically treated epidural metastatic spine disease.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Leonard Westermann,Alain Christoph Olivier,Christina Samel,Peer Eysel,Christian Herren,Krishnan Sircar,Kourosh Zarghooni

    BACKGROUND Prognostic scores have been proposed to guide the treatment of patients with metastatic spine disease (MSD), but their accuracy and usefulness are controversial. The aim of this study was to evaluate seven such prognostic scoring systems. The following prognostic scores were compared: Tomita, Van der Linden (VDL), Bauer modified (BM), Oswestry Spinal Risk Index (OSRI), Tokuhashi original (T90), Tokuhashi revised (TR05), and modified Tokuhashi revised (TR17). METHODS We retrospectively reviewed all our patients who underwent surgery for spinal metastases, February 2008-January 2015. We classified all 223 patients into the predicted survival-time categories of each of the 7 scoring systems and then tallied how often this was correct vis-à-vis the actual survival time. Accuracy was also assessed using receiver operating characteristic (ROC) analysis at 1, 3, and 12 months. RESULTS The median (95% CI) survival of the 223 patients was 13.6 (7.9-19.3) months. A groupwise ROC analysis showed sufficient accuracy for 3-month survival only for TR17 (area under the curve [AUC] 0.71) and for 1-year survival for T90 (AUC 0.73), TR05 (AUC 0.76), TR17 (AUC 0.76), Tomita (AUC 0.77), and OSRI (AUC 0.71). A pointwise ROC score analysis showed poor prognostic ability for short-term survival (1 and 3 months) with sufficient accuracy for T90 (AUC 0.71), TR05 (AUC 0.71), TR17 (AUC 0.71), and the Tomita score (AUC 0.77) for 1-year survival. CONCLUSION The TR17 was the only prognostic system with acceptable performance here. More sophisticated assessment tools are required to keep up with present and future changes in tumor diagnostics and treatment.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Individual variations of the superior petrosal vein complex and their microsurgical relevance in 50 cases of trigeminal microvascular decompression.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Mohammed Basamh,Nico Sinning,Uwe Kehler

    BACKGROUND We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury. METHODS Microvascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features. RESULTS Applied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed. CONCLUSIONS The extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.

    更新日期:2019-11-01
  • Face-to-face four hand technique in vestibular schwannoma surgery: results from 256 Danish patients with larger tumors.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Jacob Bertram Springborg,Jeppe Mathias Lang,Kåre Fugleholm,Lars Poulsgaard

    BACKGROUND The objective of this study was to investigate the clinical outcome after microsurgical treatment of vestibular schwannomas using face-to-face four hand technique in 256 Danish patients treated in the Department of Neurosurgery at the Copenhagen University Hospital from 2009 to 2018. METHODS Data were retrospectively collected from patient records. RESULTS The mean tumor size was 30.6 mm and approximately 46% of the patients had tumors >30 mm. In around 1/3 of the patients a retrosigmoid approach was used and in 2/3 a translabyrinthine. In 50% of the patients, the tumor was completely removed, and in 38%, only smaller remnants were left to preserve facial function. The median operative time was approximately 2.5 h for retrosigmoid approach, and for translabyrinthine approach, it was around 3.5 h. One year after surgery, 84% of the patients had a good facial nerve function (House-Brackmann grade 1-2). In tumors ≤ 30 mm approximately 89% preserved good facial function, whereas this was only the case for around 78% of the patients with tumors > 30 mm. In 60% of the patients who had poor facial nerve function at hospital discharge, the function improved to good facial function within the 1 year follow-up period. Four patients died within 30 days after surgery, and 6% underwent reoperation for cerebrospinal fluid leakage. CONCLUSION Surgery for vestibular schwannomas using face-to-face four hand technique may reduce operative time and can be performed with lower risk and excellent facial nerve outcome. The risk of surgery increases with increasing tumor size.

    更新日期:2019-11-01
  • NTMS mapping of non-primary motor areas in brain tumour patients and healthy volunteers.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Andia Mirbagheri,Heike Schneider,Anna Zdunczyk,Peter Vajkoczy,Thomas Picht

    OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) has been increasingly used for presurgical cortical mapping of the primary motor cortex (M1) but remains controversial for the evaluation of non-primary motor areas (NPMA). This study investigates clinical and neurophysiological parameters in brain tumour patients and healthy volunteers to decide whether single-pulse biphasic nTMS allows to reliably elicite MEP outside from M1 or not. MATERIALS AND METHODS Twelve brain tumour patients and six healthy volunteers underwent M1 nTMS mapping. NPMA nTMS mapping followed using 120% and 150% M1 resting motor threshold (RMT) stimulation intensity. Spearman's correlation analysis tested the association of clinical and neurophysiological parameters between M1 and NPMA mapping. RESULTS A total of 88.81% of nTMS stimulations in NPMA in patients/83.87% in healthy volunteers in patients/83.87% in healthy volunteers did not result in MEPs ≥ 50 μV. Positive nTMS mapping in NPMA correlated with higher stimulation intensity and larger M1 areas in patients (120% M1 RMT SI p = 0.005/150% M1 RMT SI p = 0.198). CONCLUSION Our findings indicate that in case of positive nTMS mapping in NPMA, MEPs originate mostly from M1. For future studies, MEP parameters and TMS coil rotation should be studied closely to assess the risk for postoperative motor deterioration.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Fully endoscopic transoral resection of high cervical osteophyte. How I do it?
    Acta Neurochir. (IF 1.834) Pub Date : null
    Pablo Sanromán-Álvarez,Pedro González-Vargas,José Luis Rodríguez-Fernández,Adolfo De la Lama-Zaragoza

    BACKGROUND Fully endoscopic transoral approaches (FETOA) constitute a reasonable option for the treatment of middling compressive pathology that involve the craniocervical junction and higher cervical levels. METHODS We describe, step by step, the FETOA for the treatment of upper cervical lesions. More specifically, the ones that are located between C1 and C3. A giant anterior C1-C2 osteophyte resection will be used as an illustration of these approaches. CONCLUSIONS This technique represents a minimally invasive treatment option for these kinds of high cervical lesions. It offers optimal visualization, maximizing the resection of these lesions and decreasing the morbidity and mortality.

    更新日期:2019-11-01
  • Automatic volumetry of cerebrospinal fluid and brain volume in severe paediatric hydrocephalus, implementation and clinical course after intervention.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Florian Grimm,Florian Edl,Isabel Gugel,Susanne R Kerscher,Benjamin Bender,Martin U Schuhmann

    BACKGROUND In childhood hydrocephalus, both the amount of cerebrospinal fluid and the brain volume are relevant for the prognosis of the development and for therapy monitoring. Since classical planar measurements of ventricular size are subject to strong limitations, imprecise and neglect brain volume, 3D volumetry is most desirable. We used and evaluated the robust segmentation algorithms of the freely available FSL-toolbox in paediatric hydrocephalus patients before and after specific therapy. METHODS Retrospectively 76 pre- and postoperative high-resolution T2-weighted MRI sequences (true FISP, 1 mm isovoxel) were analyzed in 38 patients with paediatric hydrocephalus (mean 4.4 ± 5.1 years) who underwent surgical treatment (ventriculo-peritoneal (VP) shunt n = 22, endoscopic third ventriculostomy (ETV) n = 16). After preprocessing, the 3D-datasets were skull stripped to estimate the inner skull surface. Following, a 2 class segmentation into different tissue types (brain matter and CSF) was performed. The volumes of CSF and brain were calculated. RESULTS The method could be implemented in an automated fashion in all 76 MRIs. In the VP shunt cohort, the amount of CSF (p < 0.001) decreased. Consecutively brain volume increased significantly (p < 0.001). Following ETV, CSF volume (p = 0.019) decreased significantly (p = 0.012) although the reduction was less pronounced than after shunt implantation. Brain volume expanded (p = 0.02). CONCLUSION A reliable automated segmentation of CSF and brain could be performed with the implemented algorithm. The method was able to track changes after therapy and detected significant differences in CSF and brain volumes after shunting and after ETV.

    更新日期:2019-11-01
  • Correction to: Prior bariatric surgery lowers complication rates following spine surgery in obese patients.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-05
    Peter G Passias,Samantha R Horn,Dennis Vasquez-Montes,Nicholas Shepard,Frank A Segreto,Cole A Bortz,Gregory W Poorman,Cyrus M Jalai,Charles Wang,Nicholas Stekas,Nicholas J Frangella,Chloe Deflorimonte,Bassel G Diebo,Micheal Raad,Shaleen Vira,Jason A Horowitz,Daniel M Sciubba,Hamid Hassanzadeh,Renaud Lafage,John Afthinos,Virginie Lafage

    The AHRQ (Agency for Healthcare Research and Quality) has requested the correction of the result Tables 1-3 of this study: All stated numbers below 10 shall be modified to read "<10" instead.

    更新日期:2019-11-01
  • sEVD-smartphone-navigated placement of external ventricular drains.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Christian V Eisenring,Felice Burn,Michelle Baumann,Lennart H Stieglitz,Ralf A Kockro,Jürgen Beck,Andreas Raabe,Markus F Oertel

    BACKGROUND Currently, the trajectory for insertion of an external ventricular drain (EVD) is mainly determined using anatomical landmarks. However, non-assisted implantations frequently require multiple attempts and are associated with EVD malpositioning and complications. The authors evaluated the feasibility and accuracy of a novel smartphone-guided, angle-adjusted technique for assisted implantations of an EVD (sEVD) in both a human artificial head model and a cadaveric head. METHODS After computed tomography (CT), optimal insertion angles and lengths of intracranial trajectories of the EVDs were determined. A smartphone was calibrated to the mid-cranial sagittal line. Twenty EVDs were placed using both the premeasured data and smartphone-adjusted insertion angles, targeting the center of the ipsilateral ventricular frontal horn. The EVD positions were verified with post-interventional CT. RESULTS All 20 sEVDs (head model, 8/20; cadaveric head, 12/20) showed accurate placement in the ipsilateral ventricle. The sEVD tip locations showed a mean target deviation of 1.73° corresponding to 12 mm in the plastic head model, and 3.45° corresponding to 33 mm in the cadaveric head. The mean duration of preoperative measurements on CT data was 3 min, whereas sterile packing, smartphone calibration, drilling, and implantation required 9 min on average. CONCLUSIONS By implementation of an innovative navigation technique, a conventional smartphone was used as a protractor for the insertion of EVDs. Our ex vivo data suggest that smartphone-guided EVD placement offers a precise, rapidly applicable, and patient-individualized freehand technique based on a standard procedure with a simple, cheap, and widely available multifunctional device.

    更新日期:2019-11-01
  • Cost determinants in management of brain arteriovenous malformations.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-25
    Caleb Rutledge,Jeffrey Nelson,Alex Lu,Peyton Nisson,Soren Jonzzon,Ethan A Winkler,Daniel Cooke,Adib A Abla,Michael T Lawton,Helen Kim

    INTRODUCTION There is little data on the cost of treating brain arteriovenous malformations (AVMs). The goal of this study then is to identify cost determinants in multimodal management of brain AVMs. METHODS One hundred forty patients with brain AVMs prospectively enrolled in the UCSF brain AVM registry and treated between 2012 and 2015 were included in the study. Patient and AVM characteristics, treatment type, and length of stay and radiographic evidence of obliteration were collected from the registry. We then calculated the cost of all inpatient and outpatient encounters, interventions, and imaging attributable to the AVM. We used generalized linear models to test whether there was an association between patient and AVM characteristics, treatment type, and cost and length of stay. We tested whether the proportion of patients with radiographic evidence of obliteration differed between treatment modalities using Fisher's exact test. RESULTS The overall median cost of treatment and interquartile range was $77,865 (49,566-107,448). Surgery with preoperative embolization was the costliest treatment at $91,948 (79,914-140,600), while radiosurgery was the least at $20,917 (13,915-35,583). In multi-predictor analyses, hemorrhage, Spetzler-Martin grade, and treatment type were significant predictors of cost. Patients who had surgery had significantly higher rates of obliteration compared with radiosurgery patients. CONCLUSIONS Hemorrhage, AVM grade, and treatment modality are significant cost determinants in AVM management. Surgery with preoperative embolization was the costliest treatment and radiosurgery the least; however, surgical cases had significantly higher rates of obliteration.

    更新日期:2019-11-01
  • Cervical spinal arteriovenous fistula with ventral perimedullary venous drainage.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-25
    Subin Lee,David B Choi,Ketan R Bulsara

    BACKGROUND Spinal arteriovenous fistula (AVF) represents the most common type of spinal vascular lesions and is often associated with progressive neurological dysfunction. METHOD Here, we present a unique case of a spinal vascular malformation that does not fit the traditional classification schemes. The patient presented with progressive neurologic deficits resembling partial Brown-Sequard syndrome and was subsequently found to have a lesion resembling type I spinal AVF. However, this intradural fistula drained into the ventral venous plexus rather than dorsal. CONCLUSION Recognizing these rare anatomical variants is paramount in achieving successful obliteration and improved functional outcome for patients.

    更新日期:2019-11-01
  • Volumetric segmentation of glioblastoma progression compared to bidimensional products and clinical radiological reports.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-25
    Erik Magnus Berntsen,Anne Line Stensjøen,Maren Staurset Langlo,Solveig Quam Simonsen,Pål Christensen,Viggo Andreas Moholdt,Ole Solheim

    BACKGROUND Detection of progression is clinically important for the management of glioblastoma. We sought to assess the accuracy of clinical radiological reporting and measured bidimensional products to identify radiological glioblastoma progression. The two were compared to volumetric segmentation. METHODS In this retrospective study, we included 106 patients with histopathologically verified glioblastomas and two separate MRI scans obtained before surgery. Bidimensional products based on measurements on the axial slice with the largest tumor area were calculated, and growth estimations from the clinical radiological reports were retrieved. The two growth estimations were compared to manual volumetric segmentations. Inter-observer agreement using the bidimensional product was assessed using Kappa-statistics and by calculating the difference between two neuroradiologist in percentage change of the bidimensional product for each tumor. RESULTS Clinical radiological reports and bidimensional products showed fairly equal accuracy when compared to volumetric segmentation with an accuracy of 67% and 66-68%, respectively. There was a difference in median volume increase of 6.9 mL (2.4 vs 9.3 mL, p < 0.001) between tumors evaluated as stable and progressed based on the clinical radiological reports. This difference was 8.1 mL (2.0 vs 10.1 ml, p < 0.001) when using the bidimensional products. The bidimensional product reached a moderate inter-observer agreement with a Kappa value of 0.689. For 32% of the tumors, the two neuroradiologists calculated a difference of more than 25% using bidimensional products. CONCLUSIONS Clinical radiological reporting and the bidimensional product exhibit similar accuracy. The bidimensional product has moderate inter-observer agreement and is prone to underestimating tumor progression, as an average glioblastoma had to grow 10 mL in order to be classified as progressed. These findings underline the assumption that one should try to move towards volumetric assessment of glioblastoma growth in the future.

    更新日期:2019-11-01
  • Meteorological factors for subarachnoid hemorrhage in the greater Düsseldorf area revisited: a machine learning approach to predict the probability of admission of patients with subarachnoid hemorrhage.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-25
    Hans-Jakob Steiger,Athanasios K Petridis,Angelo Tortora,Hendrik-Jan Mijderwijk,Kerim Beseoglu,Jasper H van Lieshout,Marcel A Kamp,Igor Fischer

    BACKGROUND Reported data regarding the relation between the incidence of spontaneous subarachnoid hemorrhage (SAH) and weather conditions are conflicting and do so far not allow prognostic models. METHODS Admissions for spontaneous SAH (ICD I60.*) 2009-2018 were retrieved form our hospital data base. Historical meteorological data for the nearest meteorological station, Düsseldorf Airport, was retrieved from the archive of the Deutsche Wetterdienst (DWD). Airport is in the center of our catchment area with a diameter of approximately 100 km. Pearson correlation matrix between mean daily meteorological variables and the daily admissions of one or more patients with subarachnoid hemorrhage was calculated and further analysis was done using deep learning algorithms. RESULTS For the 10-year period from January 1, 2009 until December 31, 2018, a total of 1569 patients with SAH were admitted. No SAH was admitted on 2400 days (65.7%), 1 SAH on 979 days (26.7%), 2 cases on 233 days (6.4%), 3 SAH on 37 days (1.0%), 4 in 2 days (0.05%), and 5 cases on 1 day (0.03%). Pearson correlation matrix suggested a weak positive correlation of admissions for SAH with precipitation on the previous day and weak inverse relations with the actual mean daily temperature and the temperature change from the previous days, and weak inverse correlations with barometric pressure on the index day and the day before. Clustering with admission of multiple SAH on a given day followed a Poisson distribution and was therefore coincidental. The deep learning algorithms achieved an area under curve (AUC) score of approximately 52%. The small difference from 50% appears to reflect the size of the meteorological impact. CONCLUSION Although in our data set a weak correlation of the probability to admit one or more cases of SAH with meteorological conditions was present during the analyzed time period, no helpful prognostic model could be deduced with current state machine learning methods. The meteorological influence on the admission of SAH appeared to be in the range of only a few percent compared with random or unknown factors.

    更新日期:2019-11-01
  • Radiographic measurements of cervical alignment, fusion and subsidence after ACDF surgery and their impact on clinical outcome.
    Acta Neurochir. (IF 1.834) Pub Date : null
    Thomas Obermueller,Arthur Wagner,Lorenz Kogler,Ann-Kathrin Joerger,Nicole Lange,Jens Lehmberg,Bernhard Meyer,Ehab Shiban

    BACKGROUND Some recent studies indicate correlations between cervical alignment and clinical outcome after anterior cervical discectomy and fusion (ACDF) surgery. However, there still are no established criteria for the interpretation of alignment, fusion and subsidence in relation to clinical outcome. METHODS A retrospective analysis of 208 radiographs of patients following ACDF with stand-alone PEEK cage implantation was performed. The measurements were obtained on plain radiographs in lateral and anteroposterior projections as well as flexion/extension radiographs. Cervical alignment was measured using the Gore, Laing and Cobb methods; fusion was evaluated by an assortment of radiographic hallmarks: the presence of bridging bone, the Cobb angle and the distances between the tips and bases of the spinous processes of the operated segments, respectively. For assessment of subsidence, we used the Mochida method in addition to ventral and dorsal segmental height reduction. Correlation analysis between the different radiological characteristics and clinical outcome at a minimum follow-up of 12 months was conducted. RESULTS Two hundred and eight patients were evaluated for alignment, fusion and subsidence. Cervical alignment using the Gore and Cobb methods correlated among each other, but failed to exhibit significant correlation with clinical outcome. Interpretation of fusion rates varied greatly (43.9 to 89.4%) depending on the criteria used. Pearson coefficients between radiographic presence of pseudarthrosis and the measurements of the spinous process distances (0.595; p < 0.001), the Cobb angles (0.187; p = 0.007) and the presence of bridging bone (0.224; p < 0.001) each exhibited statistical significance. None of the methods employed significantly correlated with clinical outcome. Regarding subsidence, we found rates of 62%, 48% and 27% using the Mochida, ventral and dorsal segmental height reduction assessment methods, respectively. Pearson correlations between pairs of Mochida/ventral (r = 0.39; p = 0.66) and Mochida/dorsal (r = 0.007; p = 0.921) height reduction assessment methods were weak and no significant correlation between subsidence rates and clinical outcome was shown. CONCLUSION All measured parameters varied depending in the measurement method used. This was most pronounced for fusion. There was a moderate positive correlation between neck pain and subsidence as measured by the Mochida method.

    更新日期:2019-11-01
  • Response to letter to the editor regarding "A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury".
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-09
    Ryuta Nakae,Shoji Yokobori,Yasuhiro Takayama,Takahiro Kanaya,Yu Fujiki,Yutaka Igarashi,Go Suzuki,Yasutaka Naoe,Akira Fuse,Hiroyuki Yokota

    更新日期:2019-11-01
  • How I do it: tapered rod placement across the cervicothoracic junction for augmented posterior constructs.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-07
    William Clifton,Aaron Damon,Mark Pichelmann

    BACKGROUND Posterior instrumentation techniques are commonly employed for cervicothoracic fixation. The pedicles of the upper thoracic vertebrae can typically accommodate larger diameter screws than the subaxial cervical vertebrae. In many construct systems, this requires the use of a tapered rod, which can be technically challenging to place. METHOD Using a three-dimensionally printed biomimetic spine simulator, we illustrate the stepwise process of instrumentation and tapered rod placement across the cervicothoracic junction (CTJ). CONCLUSION Tapered rod systems can augment the biomechanical stability of cervicothoracic constructs. Ease of rod placement across the CTJ hinges upon a systematic method of instrumentation.

    更新日期:2019-11-01
  • Correlations between the trigeminal nerve microstructural changes and the trigeminal-pontine angle features.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-07
    Huize Pang,Hao Sun,Guoguang Fan

    BACKGROUND Morphological and microstructural changes of the trigeminal nerve due to neurovascular compression (NVC) have been reported in primary trigeminal neuralgia (PTN) patients. This investigation was to examine the relationship between the trigeminal-pontine angle and nerve microstructural changes. METHODS Twenty-five patients underwent microvascular decompression (MVD) for trigeminal neuralgia, and 25 age- and sex-matched controls were studied. The two groups underwent high-resolution three-dimensional MRI and diffusion tensor imaging (DTI). Bilateral trigeminal-pontine angle, cross-sectional area of cerebellopontine angle (CPA) cistern, and the length of trigeminal nerve were evaluated. The mean values of fractional anisotropy and apparent diffusion coefficient at the site of NVC were also measured. Correlation analyses were performed for the trigeminal-pontine angle and the diffusion metrics (FA and ADC) in PTN patients. RESULTS The mean trigeminal-pontine angle and FA value on the affected side was significantly smaller than the unaffected side and the control group (p < 0.001), while the mean ADC value was significantly increased (p < 0.01). When taking the conflicting vessel types into consideration, the angle affected by the superior cerebellar artery (SCA) was statistically sharper than when affected by other vessels (p < 0.01). However, there were no significant changes in the area of the CPA cistern or the length of the trigeminal nerve between the groups. Correlation analyses showed that the trigeminal-pontine angle was positively correlated with FA and negatively correlated with ADC. CONCLUSIONS A sharp trigeminal-pontine angle may increase the chance of NVC and exacerbate nerve degeneration, which may be one of the supplementary factors that contribute to the pathogenesis of trigeminal neuralgia.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Extracapsular dissection in peripheral nerve schwannoma surgery using bright light and fluorescein sodium visualization: case series.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-11-05
    Michel Kalamarides,Isabelle Bernat,Matthieu Peyre

    BACKGROUND Schwannomas are the most frequent peripheral nerve sheath tumors and are treated by surgical resection when symptomatic. Tumor removal is performed by intraneural dissection and enucleation. In order to safely remove the tumor from the nerve, the use of sodium fluorescein has recently been proposed to distinguish the tumor from the adjacent normal nerve fibers, before incision of the tumor pseudocapsule and during intraneural tumor dissection. METHODS We report a consecutive case series of 5 peripheral nerve schwannomas operated in 4 patients, in which we evaluate the usefulness of sodium fluorescein compared to usual visual landmarks, at each step of the surgical procedure. RESULTS After exposition of the schwannoma, sodium fluorescein helped with the localization of intracapsular en passant nerve fascicles in only one case. Hence, the definition of a safe entry zone for capsular incision relied mainly on nerve monitoring and direct visualization of en passant nerve fascicles under microscope. During intraneural dissection, there was a sharp contrast between the fluorescent tumor and the non-fluorescent adjacent pseudocapsule in most cases but the colorimetric variation between tumor and normal tissue induced by fluorescence did not outperform the natural contrast between the yellow true capsule and the gray-red layers of the pseudocapsule. CONCLUSION Based on these results, we consider that the limited additional value of sodium fluorescein in primary peripheral nerve schwannoma surgery does not warrant its use in daily clinical practice. Additional studies are needed to assess its usefulness during the surgery of recurrences and tumors which are intertwined with several fascicles of origin such as neurofibromas.

    更新日期:2019-11-01
  • Range of voluntary neck motility predicts outcome of pallidal DBS for cervical dystonia.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-30
    Ryoong Huh,Moonyoung Chung

    BACKGROUND The effectiveness of pallidal deep brain stimulation (GPi DBS) for cervical dystonia has been extensively described, but controversies exist about which prognostic factor is clinically useful. We previously reported that classification of tonic- or phasic-type cervical dystonia is useful for predicting clinical prognosis; however, the approach used by physicians to distinguish between the two types remains subjective. OBJECTIVE The aim of this study was to develop a prognostic factor of GPi DBS for cervical dystonia. METHODS By identifying distributions of range of motion scores between phasic- and tonic-type cervical dystonia, a new prognostic factor group was developed based on whether the patients could voluntarily move their head to the opposite side against dystonic motions. The prognosis for GPi DBS in the two groups was analyzed according to the time sequence. RESULTS Patients who were able to move their head past the midline had a better long-term prognosis after GPi DBS than did those who could not. In the early post-operative phase, there were no significant differences in the clinical outcomes between the two groups. CONCLUSION A range of voluntary neck motility with respect to the midline is an objective factor that is useful in predicting the prognosis of patients with cervical dystonia. This result renders needs for future study addressing neuroplastic changes in the brain network caused by GPi DBS.

    更新日期:2019-11-01
  • Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury: an observational study.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-30
    Matias Lindfors,Caroline Lindblad,David W Nelson,Bo-Michael Bellander,Jari Siironen,Rahul Raj,Eric P Thelin

    BACKGROUND The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. METHODS All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999-2015, Stockholm 2005-2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1-3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. RESULTS Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores' AUCs and pseudo-R2s varied between 0.77-0.90 and 0.35-0.60 for mortality prediction and between 0.85-0.89 and 0.50-0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R2 0.53) prediction. None of the CT scores increased the base model's AUC (p > 0.05) yet increased its pseudo-R2 (0.09-0.15) for unfavorable outcome prediction. CONCLUSION Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted.

    更新日期:2019-11-01
  • Ultrasound-based real-time neuronavigated fluorescence-guided surgery for high-grade gliomas: technical note and preliminary experience.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-28
    Alessandro Villa,Gabriele Costantino,Francesco Meli,Antonino Odierna Contino,Alessia Imperato,Natale Francaviglia

    BACKGROUND The extent of resection (EOR) plays a fundamental role in the prognosis of patients with high-grade gliomas (HGG). One of the main challenges in achieving a complete resection is the distinction between tumor and normal brain. Nowadays, several technologies are employed to obtain a higher tumor removal rate and respect the normal tissue in glioma surgery and in the last decades, fluorescein sodium (FS) and intraoperative ultrasound (IOUS) have been widely used. The aim of our technical note is to demonstrate how combining these two tools offers an ultrasound-based real-time neuronavigated fluorescence-guided surgery in order to optimize HGG removal. METHODS Five patients (3 males, 2 females; mean age 55.2 years, range 36-68 years) undergoing craniotomies for removal of intraaxial lesions suggestive of high-grade gliomas on preoperative MRI were included in the study. Intraoperative navigated B-mode and CEUS associated with sodium fluorescein were used in all cases; white light appearance, IOUS, and fluorescence findings were recorded immediately after each surgery. Also, extent of resection was evaluated on postoperative Gd-enhanced MRI performed within 72 h. RESULTS All tumors effectively stained yellow with fluorescein sodium during the surgical procedure and four were well delineated by IOUS. IOUS was repeated frequently (average 2.6 time) to obtain an orientation of the gross residual tumor with respect to anatomical landmarks as the surgery proceeded. Tumor removal was completed under Yellow 560 filter. CONCLUSIONS In our technical report, we demonstrate that combining intraoperatively fluorescein sodium and IOUS improves the information and facilitates making decisions during the HGG surgery. Further experience gained in larger studies will help confirm these findings.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Spheno-orbital meningiomas.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-28
    Abbas Amirjamshidi,Kazem Abbassioun

    更新日期:2019-11-01
  • Preoperative radiographic clues for transdural disc herniation: could it be predictable?
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-28
    Moo Sung Kang,Jeong Yoon Park,Sung Uk Kuh,Dong Kyu Chin,Keun Su Kim,Byung Ho Jin,Yong Eun Cho,Kyung Hyun Kim

    BACKGROUND Transdural disc herniation (TDH) is a rare event accounting for 0.3-1.5% of all disc herniation cases. Considering the risk of leakage of the cerebrospinal fluid from the dural defect after removal of TDH or incomplete removal, it is very important to recognize TDH before surgery. This study is a retrospective case analysis to analyze the imaging findings of seven cases and to construct a preoperative prediction model for TDH. METHODS Retrospective radiographic examination was performed among patients operated for TDH in two institutions from 2008 to 2018. The radiographic images were analyzed according to the following eight signs: including absence of dural tent, complete block of spinal canal, hawk-beak sign, double-layered lesion, increased distance between the dura and cauda equina, rim enhancement, dural tent enhancement, and epidural gas. To clarify the predictive ability of these radiographic signs, consecutive 131 surgically confirmed epidural disc herniation (EDH) patients for the last 2 years were set as a control group for TDH. The sum of radiographic findings was compared between TDH and EDH patients to determine the cutoff value. RESULTS There were 1 thoracic and 6 lumbar TDHs among 75 thoracic and 6674 lumbar disc herniation cases with an incidence of 1.33% and 0.09%, respectively. Dural tent (p = 0.000, odds ratio = 106.67), double-layered lesion (p = 0.000, odds ratio = 22.69), and distance between the dura and cauda equina (p = 0.007, odds ratio = 52.00) were statistically significantly different between TDH and EDH. According to the receiver operating characteristic curve, the cutoff value of 1.5 had 85.7% sensitivity and 90.8% specificity. CONCLUSION Preoperative imaging can be useful for TDH diagnosis. It is safe to consider the possibility of TDH in patients with more than two findings in the preoperative images.

    更新日期:2019-11-01
  • Quantitative measurement of the surgical freedom for anterior communicating artery complex-a comparative study between the frontotemporal pterional and supraorbital craniotomy; a laboratory study.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-28
    Cheng-Mao Cheng,Aclan Dogan

    OBJECTIVE To quantitatively measure surgical degree of freedom (SDF) to the anterior communicating artery (AComA) complex via removal of the orbital rim. Comparisons of SDF quadrants were made between a supraorbital and standard frontotemporal pterional craniotomy according to the surgeons' geometric microscope compass-based views. METHODS Eleven latex-injected formalin-fixed cadaveric heads; 14 sides (eight unilateral and three bilateral) were dissected. Standard frontotemporal pterional and subsequent supraorbital craniotomy approaches were conducted in each specimen. Point "0" was allocated as a point 1 cm distal to the ipsilateral A1 and A2 junction of AComA. The tip of a 10-cm long pointer was used to locate point 0. The base of the pointer stick was maneuvered outside the craniotomy in eight compass directions, with the most peripheral points expressed as target points 1-8. The center of this octagon was attributed point C. A pyramid was established by connecting the points 0, C, and 2 neighboring target points. A frameless stereotaxic instrument was used as a three-dimensional digitizer to measure pyramid volume. Each neighboring two pyramids form a hexagonal cone and was expressed as a surgical freedom quadrant (cm3). The quadrants are depicted counterclockwise (surgeons view) as orbital-nasal, vertex-nasal, vertex-temporal, and orbital-temporal. RESULTS Total SDF obtained via supraorbital and pterional approaches were 122.8 ± 109.66 and 159.94 ± 93.65, respectively (mean ± SD cm3; supraorbital < pterional by 30.2%). Supraorbital to pterional, in the orbital-nasal quadrant was 21.9 ± 35.5 and 13.04 ± 8.7, vertex-nasal 31.3 ± 28.5 and 16.7 ± 13.7, vertex-temporal 39.5 ± 42.14 and 60.4 ± 4.7, and orbital-temporal 30.14 ± 42.14 and 70.01 ± 42.14, respectively (mean ± SD cm3). In the vertex-nasal quadrant, the supraorbital approach provides a 47.3% increase in SDF compared to the standard frontotemporal pterional craniotomy approach. CONCLUSION Given that the AComA complex is located more nasally and the surgeon's view is more vertex, we propose that a supraorbital craniotomy allows a more contralateral portion of the AComA complex to be visualized during dissection.

    更新日期:2019-11-01
  • Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve.
    Acta Neurochir. (IF 1.834) Pub Date : 2019-10-28
    Fábia Silva,Pedro Santos Silva,Rui Vaz,Paulo Pereira

    BACKGROUND A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team's initial learning period. METHODS The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients' demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. RESULTS Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient's order number (r = - 0.539, p = 0.002). CONCLUSIONS In our initial experience, MIDLIF showed to be effective in significantly improving the patients' functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
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